Reimbursement

Insurance Coverage Flexibility for the Omnipod® Insulin Management System

The Omnipod® System is now more accessible than ever, as it is covered under most private insurance plans through either the: 1) medical benefit and/or the 2) pharmacy benefit. Our coverage flexibility differentiates our insulin management system from other insulin pumps, giving patients and their healthcare team the freedom to determine the best way to receive their Pods. The Omnipod® System may also be available through Medicare Part D and Medicaid.

Medical Equipment Benefit

Depending on the patient’s health insurance, the Omnipod® System may be available as durable medical equipment. This requires healthcare providers to submit a Certificate of Medical Necessity alongside our Patient Information Form. Patients’ insurance plans will dictate Pod coverage.

Pharmacy Benefit

The pharmacy channel offers simplified access to the Omnipod® System. This avenue may mean less paperwork for healthcare providers and may allow patients to manage their Pod orders alongside their other prescriptions. We currently have access through the two largest Pharmacy Benefit Managers in the nation, and are continuing to expand pharmacy access across the United States. Learn more about how to prescribe the Omnipod® System for patients with private insurance plans.

Medicare Part D Coverage

The Centers for Medicare and Medicaid Services (CMS) allow for the Omnipod® System to be covered under the Medicare Part D (prescription) program. If your patient’s Part D carrier does not yet include the Omnipod® System on their covered formulary list, our Medicare Access team can work with your patient to help them secure a formulary exception. To learn more about beginning this process, our Medicare Access team can be reached at 877-939-4384.

Medicaid Coverage

The January 2018 announcement by the Centers for Medicare and Medicaid Services (CMS) confirming the Omnipod® System’s coverage under the Medicare Part D Program may serve as an accelerant to achieving broad Medicaid access for Omnipod® System users.